Comparative Efficacy of First-Line Chemotherapy and Endocrine Therapy in Hormone Receptor-Positive HER2-Negative Metastatic Breast Cancer: A Retrospective Analysis

Shash, Emad; Gaber, Sally; Elashtoky, Hossam Eldin A.; Allahloubi, Nasr Mohamed Ali

doi:10.21608/jcbr.2025.394007.1406

Comparative Efficacy of First-Line Chemotherapy and Endocrine Therapy in Hormone Receptor-Positive HER2-Negative Metastatic Breast Cancer: A Retrospective Analysis

Document Type : Original Article

Authors

¹ Medical Oncology Department, National Cancer Institute, Cairo University

² Medical Oncology, Tanta Cancer Center, Gharbia, Egypt

³ Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt

10.21608/jcbr.2025.394007.1406

Abstract

Background International guidelines endorse endocrine therapy (ET) as first-line treatment for hormone-receptor–positive, HER2-negative metastatic breast cancer (HR+/HER2– MBC) except in the setting of visceral crisis.

Aim To compare real-world survival outcomes with first-line ET versus chemotherapy (CT) in an Egyptian cohort treated before CDK4/6 inhibitors became available.

Methods We retrospectively reviewed 200 consecutive HR+/HER2– MBC patients managed at Tanta Cancer Center between January 2013 and December 2018. Clinicopathologic variables and systemic therapies were abstracted from medical records. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method and compared with log-rank tests; independent prognostic factors were explored with multivariable Cox regression.

Results Of the 200 patients, 149 (74.5 %) received CT and 51 (25.5 %) ET as initial systemic therapy. Median OS for the entire cohort was 56 months. ET conferred a significant OS advantage over CT (median not reached vs 51.5 months; p = 0.021). Among patients presenting with visceral metastases, OS remained superior with ET (not reached vs 46 months; p = 0.003). PFS did not differ between groups (15.8 months ET vs 15.8 months CT; p = 0.816).

Conclusion In this pre-CDK4/6-inhibitor era, first-line ET was associated with longer OS than CT in Egyptian patients with HR+/HER2– MBC, even when visceral disease was present. These findings reinforce guideline-based use of endocrine-based regimens and provide a benchmark for evaluating the added value of newer targeted combinations.

Keywords